Reimbursement Advisor

Outpatient obstetric care in a hospital setting

<huc>Q</huc> A gravida presented to the labor and delivery (L&D) unit of the hospital with symptoms indicative of preterm labor. A physician examined the patient and counseled her without admitting her. Is this considered an “office visit” under the global obstetric code and, therefore, counted toward the 13 antepartum visits, or is it considered a separate E/M visit that should be billed on the date of service?

<huc>A</huc> Since the physician performed an out-patient service (because the gravida was not admitted to the hospital or for observation care), most payers may consider the visit as a part of the global care, even though the service was performed in the hospital, not in an office.

Nonetheless, bill this encounter as a separate E/M visit on the date of service. The reasons: Your claim will clearly show that the place of service was not the office, and the diagnosis code will be the patient’s presenting symptoms. This may help you obtain reimbursement outside of the global fee.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.